Keep Safe When You Take Your Baby Swimming.

We’ve all seen photographs like the one on the right. And the famous Nirvana album cover with the baby swimming underwater is now over 20 years old. The baby on that cover, Spencer Elden, was thrown into a pool and then photographed. He’s still around to tell the tale and none the worse for the experience – at least not unless you count people asking him about a certain part of his anatomy, which apparently people regularly do.

However, a 10 month-old baby in Italy was not so lucky. The Journal of Clinical Pathology reports that this baby died from “Sudden infant death triggered by dive reflex.”

The “dive reflex” is often cited as a reason it is safe to take very young babies swimming, and is mentioned it in the first video below.

But if it is also considered by pathologists to have triggered a baby’s death, what exactly is going on? Is it safe to take your very young baby swimming or not?

To attempt to answer this question, let’s take a closer look at the dive reflex.

All of us have the instinct to hold our breaths when underwater, and this applies to infants too. Some sources on the Internet claim this is the dive reflex – including the first video clip below. The truth is it is part of the dive reflex, but not all of it.

One site explains that Swedish researchers studied 21 babies (aged from 4 months to one year) and found that none of them choked or inhaled water when being submerged in water. The researchers also observed that the babies seemed to enjoy the experience.

But this same site also referred to the dive reflex as the “bradycardic response.”

Now, I know a thing or two about bradycardia. My younger daughter had more than one when she was just weeks old. They set off alarm bells on the monitors to which she was hooked up. Reading that the dive reflex is also referred to as the bradycardic response set off a few alarms bells in me, and led me to go from writing an article on teaching your baby to swim to an investigation into the safety of the much-promoted tactic of ducking a young baby’s head underwater to avoid him or her developing a fear of water.

A bradycardia episode is when lack of oxygen causes the heart rate to rapidly drop. In premature babies (my daughter was one) this generally occurs when the baby stops breathing for more than twenty seconds – this is known as apnea. Bradycardia in turn means that the blood and oxygen supply to the baby’s brain in reduced. Researchers have found that children aged 3, who as premature babies have several episodes of apnea and bradycardia, have lower scores in developmental tests than their peers. The researchers point out this does not mean we can assume the apnea and bradycardia are the cause.

So does this mean a baby’s heart rate drops significantly during the dive reflex? Yes, it does.

This is a more difficult question to answer. The diving reflex has saved many lives. Although it was originally believed that babies over 6 months lost this reflex, some studies suggest that while the bradycardia response decreases slightly, the diving reflex remains. There are recorded cases of young children surviving underwater for up to half and hour with no long term ill-effects. But there have also been cases where babies died after water births. In one case in the UK in 1992, a spokesman for the hospital involved said that baby died 15 hours after birth and an autopsy did not show any cause of death.

But while the Italian baby mentioned earlier was initially taken to the emergency room after his swimming lesson, he was discharged and then died suddenly the following night. So does what does that mean for the UK baby who died 15 hours after a water birth? Without knowing the details of the autopsy it is impossible to reach any conclusion, but some experts do consider water births to be dangerous for this very reason. One of them is Dr Amy Tuteur, whose article I have referenced at the end of this article.

My aim here is not to debate the safety of water births, but to consider the implications for submerging a small baby in water.

The baby in the Italian study was previously considered healthy. He was submerged in cold water and developed vomiting and diarrhoea. When the baby was taken to ER he was thought to have a viral infection and was treated for dehydration. The next night he died, and the autopsy indicated that the dive reflex, brought on by his face being submerged in cold water, was the cause. It could also be significant that both his parents smoked. (The link to this report is at the bottom of this article.)

Cold water is of key importance here, because, as Dr Amy Tuteur says in her article on water births, the dive reflex is not triggered by warm water. She gives this as one reason to avoid water births. The medical site emedicalhealth (link at end of article) gives the temperature required to stimulate the dive reflex as below 32F or zero centigrade – icy cold water, while Wikipedia says 21°C or 70 °F.

Most public pools that are aimed at families with babies and small children are considerably warmer than pools aimed at serious swimmers. This suggests that the dive reflex is probably not triggered in babies immersed in these pools. Likewise, the website from which the videos shown here originate states that the pools used are close to body temperature – body temperature is around 37 centigrade, and most pools vary between 28 – 32 degrees. So like me, you might now be wondering:

I’d love to be able to answer that question, but all I can do is speculate. My guess it that the way they have been introduced to the water has given them confidence to relax and enjoy the experience. Notice that the instructor holds the very small baby’s head above the water. In the second video clip babies learn to float safely on their backs. Hubber QudsiaP1 has suggested in the comments below that because that in the womb babies are immersed in liquid and get their oxygen from their mothers via the umbilical cord, it could be that babies naturally know not to breathe in warm water. The main reason for teaching a baby to swim is to keep them safe. Drowning is a major cause of death in preschool children, with babies under one most likely to drown in the bath or bucket than anywhere else. Since small children who panic are more likely to drown, confidence is the real key here. If you are unsure either of water or of taking your baby swimming, your fear is likely to transfer to your baby. I have met many, many parents who want their children to learn to swim so that they won’t develop the same fear as they, the parents, have. If this is you, I suggest you either get support for your own fear before you take your baby swimming, or find a class similar to the one featured in these videos, which will support you to get over your fear whilst also supporting your baby.

To return to the main point of this article: is it safe to immerse your baby in water? If your baby is fit, healthy and well then the answer is probably yes, but since the true dive reflex is triggered by very cold water and leads to a drop in your baby’s heart beat, I cannot see why anyone would want to rely on this.

Instead, even if you are a confident swimmer, when it comes to introducing your baby to the water, it is wise to pick a reputable swim class where the instructor has plenty of experience of working with babies. Our first daughter soon showed a love of water but I wasn’t sure how to teach her to swim. By taking part in a class I learned how to help her build up confidence. The class we joined did a lot of singing, and at the age of three my daughter was surprised to hear someone sing: “Ring a ring a roses,” on dry land. She thought it meant being lifted up and down in a swimming pool. Because my second daughter was born very premature we waited till she was over a year old before taking her to a pool. At the first attempt she was not impressed, and the instructor suggested we simply sit with her at the edge of the pool until she felt safe. By the end of the lesson she was happy to be in the water. Both my daughters are now very keen and capable swimmers. Your children can be too.

The report on the Italian baby: Sudden infant death triggered by dive reflex

Dr Amy Tuteur’s article:The diving reflex: a little knowledge is a dangerous thing

The emedicinehealth information: Drowning

Information on bradycardia: What are Apnea and Bradycardia?